Improving Management of Chronic Heart Failure by Implementing a Provider In-Home Visits Program Restricted; Files Only

Castro-Revoredo (Fall 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/9019s355t?locale=en
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Abstract

Chronic Heart Failure (CHF) is a common medical problem affecting approximately 5.8 million people in the United States and about 26 million people worldwide. CHF is a chronic and progressive clinical condition in which the heart is not able to meet the body’s needs, usually due to coronary heart disease, long-term hypertension, diabetes, or other baseline heart diseases. It is the most common cause of hospital admissions in the US.

According to the ACC/AHA, close to 25% of patients hospitalized with CHF are readmitted to the hospital within 30 days and 50% are readmitted in the first 6 months after discharge. Evidence suggest that close follow up (in the first month) after discharge from Emergency Department (ED) visit, by a physician who knows the patient have better outcome than those without follow up, or who were followed by a non-familiar physician.  

About 30% of patients at the Grady CHF clinic fail to keep their appointments for different reasons. This at high risk population of patients would benefit from other options to receive outpatient medical care for CHF disease and prevent its complications. The aim of this proposal is to improve the management of CHF among patients who miss their appointments in CHF clinic and have higher rate of ED visits, admissions and readmissions to the hospital and poor quality of life (QOL). The main hypothesis is that in-home medical visits can help improve the management of CHF in this population, help decrease ED visits, hospitalizations and re-hospitalizations, and improve their quality of life. Upon completion we will learn the attitudes and acceptance of the patients toward the program and the challenges that prevent them from being compliant with the clinic visits will provide in home medical care to the patients that cannot keep their appointments. The study is innovative since there is not any specific in-home medical visit program addressing the needs of this population at Grady. 

Table of Contents

Chapter I. 1

Introduction. 1

Theoretical Framework. 4

Significance of the Study. 5

Chapter II. 5

Literature Review.. 5

Overview of Patient and Family Burden Associated with CHF. 6

Physical and Psychological Effects of CHF. 6

Current Care Methods Used for Diagnosis and Care of CHF. 7

Structure of Care of CHF. 7

Team and Evidence-Based Approaches. 9

Specialized CHF Clinics 11

Missing appointments: causes and consequences. 13

Issues of Hospitalization and Re-hospitalization. 14

Role of the Patient’s Family and Environment when Taking Care of CHF. 17

Provider in-Home Visits in Patients with Chronic Diseases and CHF. 18

Chapter III. 21

Methodology. 21

Review of the Types of funding agencies. 24

Summary of the Grant Announcement 24

Grant Review Process. 25

Grant Proposal Reviewers and their Expertise. 25

Optimal Protection of Human Subjects. 26

Chapter IV.. 27

Critiques of the reviewers and description of incorporation of their comments. 27

Reviewer # 1. 27

Reviewer # 2. 29

Reviewer # 3. 30

Reviewer # 4. 31

APPENDIX 1. 33

Chapter V.. 36

Grant with incorporated reviewers’ critiques. 36

PROJECT SUMMARY/ABSTRACT.. 36

PROJECT NARRATIVE/RELEVANCE: 37

FACILITIES AND OTHER RESOURCES. 37

SPECIFIC AIMS. 37

REASEARCH STRATEGY: 38

C 3) RESEARCH PLAN.. 44

References. 48

DETAILED BUDGET FOR INITIAL BUDGET PERIOD.. 53

DIRECT COSTS ONLY. 53

A.           Personal Statement 55

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